Key result
Carotid endarterectomy successfully prevented the recurrence of ischemic stroke events over 2 to 3 years of follow-up in two patients with mild (<50%) cervical carotid artery stenosis.
Why the study?
Does carotid endarterectomy prevent recurrent ischemic stroke in patients with mild cervical carotid artery stenosis (<50%) and ulcerated echolucent plaque refractory to medical treatment?
Case Report (n=2)
No
Does carotid endarterectomy prevent recurrent ischemic stroke in patients with mild cervical carotid artery stenosis (<50%) and ulcerated echolucent plaque refractory to medical treatment?
Carotid endarterectomy may be an effective treatment to prevent recurrent stroke in patients with mild (<50%) carotid stenosis associated with ulcerated echolucent plaque who are refractory to medical therapy.
Hypothesis-generating for endarterectomy in refractory mild carotid stenosis; should not change practice pending controlled trials.
A 62-year-old man and a 44-year-old man with unilateral cervical carotid artery stenosis (less than 50% with echolucent plaque and ulceration) suffered recurrent ischemic stroke events despite treatment with antiplatelet and anticoagulation drugs. Carotid endarterectomy (CEA) was performed under transcranial Doppler monitoring for the detection of micro-emboli using a microscope inserted through a skin incision to minimize pressure on the carotid arteries. The atheroma plaque included an ulcer with fresh thrombi in both patients. Both patients awoke from anesthesia without new neurological deficits, and no ischemic stroke events have recurred since CEA. Endarterectomy is an effective method for preventing stroke in patients with severe carotid stenosis (>70%), but the efficacy of this procedure for mild carotid stenosis (<50%) remains uncertain, regardless of carotid plaque characteristics. The present cases suggest that even mild stenosis of the cervical carotid artery may result in ischemic stroke events that are refractory to medical treatment if the stenosis is associated with echolucent plaque with ulceration. Endarterectomy is recommended to prevent further stroke in such patients.
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Kobayashi et al. (2008) conducted a case report in Mild cervical carotid artery stenosis with recurrent ischemic stroke (n=2). Carotid endarterectomy was evaluated on Recurrence of ischemic stroke events. Carotid endarterectomy successfully prevented the recurrence of ischemic stroke events over 2 to 3 years of follow-up in two patients with mild (<50%) cervical carotid artery stenosis.
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